Defending the ACA and a Look Toward 2019

Efforts Underway to Defend the ACA

State Attorney Generals across the U.S. will be working through the Christmas holiday preparing expedited briefs supporting the Affordable Care Act (ACA).

The U.S. District Court judge in Texas that issued a controversial December 14 ruling declaring the ACA unconstitutional issued a follow-up order on December 18 requiring both sides to submit briefs explaining why his original order should be stayed or move forward.

The plaintiffs in the case (those who oppose the ACA) had until December 21 to submit their briefs, and then the defendants (18 Democratic AGs in favor of the ACA) have until December 26 to respond.

Massachusetts Attorney General Maura Healey is one of the 18 AGs whose December 17 brief asked the court to issue an order saying that regardless of the original order ruling the ACA unconstitutional, all states and individuals have to abide by the ACA until the inevitable court appeals are played out.

“An order clarifying the import of the Court’s ruling would help quell concerns about the effect of the December 14 ruling while this litigation continues and provide peace of mind to millions of Americans relying on the ACA for health insurance in 2019,” the defendants wrote.

Since Judge Reed O’Connor’s ACA ruling, legal experts on both sides of the issue have weighed in and essentially agree that the case will most likely eventually end up in the Fifth U.S. Circuit Court of Appeals.

MHA President & CEO Steve Walsh last week offered “strong support” for the efforts by AG Healey and the state’s Congressional delegation to defend the ACA. He raised concerns with the serious consequences on health coverage for Massachusetts residents, stating, “If the ruling were to stand, it would turn back the clock and cause immeasurable harm here in Massachusetts.”

Beyond its effect on health coverage, the ACA has also been instrumental in payment and delivery reforms. Walsh said, “The ACA has been a catalyst for profound innovations that have improved how healthcare is paid for and delivered for all patients, including those in the Medicare and Medicaid programs. Our hospitals and the thousands of Massachusetts healthcare employees are on the front lines of providing some of the best care in the world. They are hard at work to improve care coordination and delivery, while simultaneously responding to an opioid crisis, increased prescription drug prices, a behavioral health system in need of repair, and an aging patient population – all with limited financial resources. If we lose the support and protections provided by the ACA, progress on all of these efforts will be seriously challenged.”

Hospital executives in states that are attempting to expand their Medicaid program say the Texas court ruling – even if stayed pending appeal – could have a chilling effect on their efforts. As one executive stated in a conference call in which MHA participated last week, Republican legislators opposed to expansion efforts can use the court decision as an argument to take a “wait-and-see” stance while putting expansion efforts on the back burner.

Controlled Substance Registration Moving to Online

DPH has announced that the Massachusetts Controlled Substance Registration (MCSR) system is moving online, but that until the new system goes into effect, the state’s eLicensing system will be offline for an upgrade.

Massachusetts law requires every person who manufacturers, distributes, prescribes, administers, dispenses, or possesses controlled substances in Schedules II-V to be registered with both the MCSR and US Drug Enforcement Administration (DEA). Prescription drugs that are not federally scheduled (Schedule VI) are recognized as controlled substances under state law, and for these, practitioners only need to get an MCSR, and not a DEA number.

Affected practitioners will be able to apply for and renew their MCSR through the same system that the Bureau of Health Professions Licensure Boards already use. But the system will be offline from Friday, December 28 from 2 p.m. until Monday, January 7, 2019, at 10 a.m. to allow for the MCSR upgrade. Because of the inconvenience, DPH says all Bureau of Health Professions Licensure boards will waive license renewal late fees until March 7, 2019, for all licenses and permits due to expire between December 28, 2018 through January 7, 2019; and will allow early renewals.

Additional information is available here. MCSR will hold several webinars in January; specific dates and times and other details are available here.

Some Things to Expect in 2019

The healthcare system always throws some unexpected curves, causing hospitals and policy makers to adjust mid-course. Ongoing political disputes over the Affordable Care Act, continuing concern over opioids and behavioral health system breakdowns introduce uncertainty. But as 2019 begins, here are a few key developments that should occur without fail.

Budget season begins in January when Governor Baker submits his FY2020 proposal. In September (2018), the state released its 2019 acute care hospital Request for Applications (RFA), which is the main contract between the state and hospitals serving Medicaid/MassHealth patients. That RFA contained notable changes affecting reimbursement, including payment for complex care provided to MassHealth patients. Through the budget process and working directly with MassHealth, MHA and its members will seek to address the problematic payment reductions hospitals are facing in the RFA.

Last week Mass. Health & Human Services Secretary Marylou Sudders was interviewed in CommonWealth magazine’s “Health and Consequences” podcast, and indicated that the administration will be focusing on community hospitals. Specifically she said, “"This coming year, as we revisit health reform in the commonwealth, we need to ensure that people have access to the community hospitals. I can't tell you what that's going to look like at this moment, but stay tuned…” Sudders also promised “another MassHealth pharmacy reform, 1) that guarantees access, 2) goes for direct negotiations with manufacturers, and 3) has strong consumer protections.”

MHA plans to roll out some interesting initiatives in 2019 focusing on the healthcare workforce. Stay tuned for updates to the Caring for the Caregiver initiative which focuses on employee recognition and gratitude, workplace safety, and employee wellbeing. Some concrete action steps to reduce physician burnout are in the works, as is a guidance document to help hospitals create a framework for an effective workplace violence prevention program. Also stay tuned for MHA-workgroup-created guidance to assist acute care hospitals in implementing a Medication for Addiction Treatment (MAT) program in their emergency departments or satellite emergency facilities.

In Memoriam – Richard Lee

Richard E. Lee, the former head of New England Deaconess Hospital and a former Chairman of the MHA Board of Trustees, passed away on December 7. He was 92 years old. He had a long history with New England Deaconess Hospital, beginning work there as a junior auditor for the hospital’s accounting firm upon graduation from college, then as controller, and ultimately the leader of the hospital under the title of COO by the time he retired in 1989. He went on to serve as CEO of Healthcare Services of New England until 1994. Lee was also a Beth Israel Deaconess Medical Center Overseer emeritus. He is survived by his wife, Gail G. Lee; his sister, Carol; and nieces and nephews. A celebration of Dick’s life will be planned for this summer in Pocasset, Mass.

Merry Christmas, Happy Holidays, Happy New Year

The staff at MHA wishes you and yours a happy and healthy holiday season and New Year. Monday Report will return on January 7, 2019.

Lean in Healthcare at Emerson Hospital

Starting Wed., March 6, 2019; 8 sessions total

In this program, participants will learn the fundamentals of continuous improvement in a classroom setting. They will then work in teams to apply the principles and tools of continuous improvement in an actual healthcare process at Emerson Hospital in Concord. Each day participants will be introduced to appropriate best practices. This learn-by-doing method will prepare students to return to their own workplaces with the confidence to implement continuous improvement methodologies. The program will be held Emerson Hospital so that a combination of classroom and hands-on learning can take place. Learn details, all scheduled dates, and costs by clicking here.